Posts By / Luisa Cescutti-Butler

Student midwives spend approximately 50% of their three year undergraduate programme in the clinical area. Going to a new placement is often a stressful time for them as they consider ‘will they fit in’, ‘will they know enough’, ‘have they the right skills’, ‘what will they be able to learn whilst there to meet their practice assessments’ and so on. Other concerns relate to being away from home, what hours they are expected to do and how they cope with ‘difficult’ mentors. If students are unfamiliar with healthcare environments it takes time for them to adjust and become used to the environment. It was these thoughts that began fermenting in my head back in 2010 and following a positive response from students whose views on a book on placements were informally sought, I pitched the idea to a commissioning editor at Wiley Blackwell. In addition wider research had revealed that no such book existed within the published midwifery arena. Finally, in 2012 a contract was agreed between myself, and Margaret Fisher, Associate Professor in Midwifery at Plymouth University to co-edit nine chapters for submission in November 2014. The book is now due for publication on the 11th December 2015.
Professor Paul Lewis wrote the forward and chapter contributions from Bournemouth University lecturers, Dr. Sue Way, Stella Rawnson and myself, prepare prospective and current students for midwifery practice and the profession, caseloading and the elective period. Jo Coggins and Henrietta Otley, both midwives practising in North Wiltshire were co-opted to write chapters on ‘Preparing for practice’ and ‘Low-risk midwifery placements’. Other chapters were written by Margaret Fisher and Faye Doris at Plymouth University.
The final published edition is small enough to fit into a uniform pocket and contains many vignettes from students currently or previously studying at Bournemouth and Plymouth University. Their stories reflect ‘real life’ clinical experience and ‘Top Tips’ provide overall advice. Three original cartoons illustrating the vagaries of placement were devised by Clare Shirley (formerly a BU student, now a newly qualified midwife) and Hugo Beaumont (4th year medical student at Plymouth University). Students and women have provided photographs. Both Margaret and I hope students far and wide will enjoy the book which aims to provide a realistic perspective on clinical placement, by offering hints and tips and encouragement along their student journey.

In November last year I published a blog on the first pilot project I undertook with five under-graduate pre-registration midwifery students which was designed to enable them to qualify with the skills and competencies around examination of the newborn (EXON). The students were required to access and study the module with post-graduate midwives. Four of the students successfully completed the course in September 2014 with one student leaving early on in the project due to unforeseen family circumstances. The journey to completion was not smooth. The first hurdle was a clash of assessments. The EXON assessment (a presentation) fell in the same week as Complex Care (CC), a third year unit assessment where students are required to undergo a VIVA and manage two obstetric emergencies. It is a stressful experience and therefore three of the students requested an extension to their EXON presentation with only one choosing to present with her post-registration colleagues. As the EXON assessment took place on the Monday of that particular week and Complex Care assessments were running over three days, the student managed to negotiate to undertake her CC assessment on the Friday. The three students were re-scheduled to present later in the year with a number of other midwives who were on extensions or resits.One of the advantages of choosing to present in January 2014 was that the student was able to choose a topic that she could use both for her learning around EXON and for her extended essay which was due to be completed somewhat later in the academic year. The student was successful in both endeavours as were all the others but at a later date.

Another hurdle students found themselves confronted with, was a lack of opportunity to undertake newborn examinations including a shortage of midwifery mentors who could support the training requirements of the project. Two of the students could not get any of the examinations done in their own trusts. Fortunately for them, the maternity unit and midwifery staff at Poole NHS Trust Hospital were extremely obliging and supported the students to work there which enabled them to complete the practical newborn checks. All four of the students have successfully qualified as midwives and have obtained midwifery posts in the local area. They remain committed EXON and have volunteered to be EXON ‘champions’ within their respective trusts. I am grateful to Jeanette Elliot, Luzie Schroter, Jenna Penhale and Bex Coleman-Moss for their hard work and dedication during the pilot and for their feedback and advice for the next intake.

Demand for places for the second pilot project remained high when the call was put out a short while ago. Unfortunately due to some of the barriers described above it was only feasible to recruit five students again and all of them based in the west. The students have commenced their studies and are enjoying the learning so far. The pilot projects are helping to inform what impact these barriers will have on the training needs for midwifery students within our local maternity units as this year we are introducing EXON theory to all midwifery students on our newly validated curriculum with the caveat that students will obtain the necessary theoretical knowledge but not all with qualify with the required skills. However by ‘fast-tracking’ students onto one of our twice yearly CPD EXON modules which has around 20+ midwives enrolled, by the time the students reach their third year there should be many more midwives qualified in EXON and in place to support our under-graduate students to gain the competencies around newborn examination.If you require any further information please contact Luisa Cescutti-Butler on lcbutler@bournemouth.ac.uk

In the region covered by Health Education Wessex, over half of all admissions to neonatal units are babies who are considered term gestation. An audit of neonatal unit admissions undertaken by University Hospitals Southampton NHS Foundation Trust uncovered three main reasons for term admissions:

(Mal) adaptation to neonatal life (27%)

Respiratory Distress Syndrome (18%)

Sepsis (13%)

The findings suggest that with better care in the immediate and subsequent postnatal period some of these admissions may have been avoided. It appears to be a national problem with NHS England recognizing an increase in term admissions as a key concern. Separating the woman from her baby can be emotionally upsetting and may impact on a woman’s ability to successfully breastfeed her baby. Babies when admitted onto neonatal units are subject to many interventions and may suffer short term morbidities. In addition to the impact on the woman and her baby there are implications for resources, it costs £500 a day to care for a baby receiving specialist neonatal care. Units who have reduced their term admission rates cite midwifery involvement as vital.Midwives work within multidisciplinary teams; therefore involvement of all healthcare professionals is crucial if term admissions are to be reduced. Standardization of protocols and guidelines appear difficult to achieve based on the various ways services are configured, therefore education on the basic principles of prevention is required.

Following an initial meeting with Kate Graham-Williams (Locum Consultant Neonatologist), Kim Edwards (Network Educator) and Teresa Griffin (Deputy Manager/Lead Nurse) to explore ideas of developing a learning package, a further meeting took place with Luisa Cescutti-Butler, Debbee Houghton and Carol Wilkins (Senior Midwifery Lecturers) to discuss educational outcomes.The meeting concluded with all parties agreeing to work collaboratively on an e-learning package and to explore possible sources of funding. Health Education Wessex has a responsibility to ensure that NHS employees are equipped with the right skills and knowledge to deliver excellent health and patient care, therefore they were approached and agreed to provide funding. Alison Potter (E-Learning Project Manager) joined the project and is managing all stages of the project. The project which involves Health Education Wessex, Thames Valley and Wessex Neonatal Network, Bournemouth University and selected supplier (LEO) have agreed to develop, implement and evaluate a multi-disciplinary eLearning module with an aim in reducing avoidable term admissions to neonatal units.

Luisa, Debbee and Carol are working with Kate on developing content (case scenarios) of the e-learning package and a workshop with all parties including supplier LEO will be taking place in December at Bournemouth University.A number of key professionals from the Wessex region have agreed to be reviewers including a set of parents who would have experienced their baby being admitted to a neonatal unit for medical input. The project aims to be ‘live’ in March 2015.

A recent free Maternity, Midwifery & Baby Conference held in London offered an ideal opportunity for Bournemouth University to showcase two innovative projects. The first, co-presented by Dr. Sue Way and Sian Ridden, a 2nd year midwifery student, focused on a joint chiropractic and midwifery newborn clinic which was set up with Fusion principles in mind. There are a number of aims of the clinic, of which the main is to optimise women’s opportunities to breastfeed successfully by providing chiropractic care for babies and breastfeeding support and advice to mothers. There are two further important aims, one of which, is to enhance student (undergraduate midwifery students & chiropractic students) learning opportunities and secondly, to provide networking and collaborative opportunities for students and staff in relation to research and dissemination of findings around these particular topics. When it was Sian’s turn to present, she was confident and articulate. She discussed a case study and how her knowledge was enhanced by being part of the clinic. Sian found attending the clinics provided her with a great learning experience and it was empowering that she was able to provide breastfeeding support under the guidance of the experts in the respective fields (Alison Taylor and Dr. Joyce Miller). Preliminary breastfeeding results from the clinic are promising. More details to follow in due course. Finally the seminar concluded by discussing the re-launch of the clinic in September, and to raise awareness of the re-launch, a free local conference (funded by Fusion Funding) for the community will be taking place on the 12th July 2014. For further information on the above clinic or the conference please contact Alison Taylor on ataylor@bournemouth.ac.uk or Dr. Sue Way on sway@bournemouth.ac.uk .

The second seminar presentation took place after lunch and it focused on a study which is currently taking place involving five 3rd year midwifery students and the feasibility of incorporating newborn infant physical examination (NIPE) competencies into the pre-registration midwifery programme. Traditionally these competencies are usually achieved post qualification when midwives have a number of years’ experience under their belt. However BU midwifery students felt differently and Luisa Cescutti-Butler discussed how the study was initiated by Luzie who asked the question: “why couldn’t they learn all the necessary skills in the third year of their programme”? Luzie took to the podium and presented her section like a duck to water. She didn’t shy away from the difficulties from taking this extra study on, but was quite clear that the benefits for women in her care were worth the extra work. The presentation generated quite a lot of heated discussion with some midwives in the audience quite adamant that students should not be taking on this ‘extended’ skill. However Luzie was able to stand her ground and confidently counter ague as to why students should gain these skills during the undergraduate programme. She received a resounding clap and cheers from the audience.

It takes some courage to stand up in a room full of people and present, and Sian and Luzie were brilliant. Both students did Bournemouth University and in particular the midwifery team proud. For further information on the above study please contact Luisa Cescutti-Butler on lcbutler@bournemouth.ac.uk

After many months of negotiation I packed my weekend bag and set off to Eastbourne to provide the first of a six day programme spread over three months on newborn examination, to a select cohort of nine midwives who work for the East Sussex NHS Healthcare Trust. The nearest university (Brighton) does not provide the module and I regularly have midwives travelling up from Brighton to attend the two courses provided annually at the Lansdowne Campus.

Midwives from the midwife led unit (EMU as it is fondly referred to) at Eastbourne Hospital, the acute trust at Hastings and Crowbridge Birthing Unit all joined the module at the beginning of January 2014. Some of the midwives were undertaking the unit in work time and some during their annual leave, but all were enthusiastic and very excited to be finally learning the skills and competencies necessary to become newborn examiners. Currently no midwives in the combined trusts undertake newborn examination and all babies are either examined by junior doctors in training or general practitioners (GPs) in the community setting. For a number of years there have been concerns expressed in the literature around the quality of the newborn examination when undertaken by junior doctors and GPs mainly around training and on-going education. Traditionally doctors in NHS hospitals were taught newborn examination under the mantra ‘see one – do one – teach one’, midwives on the other hand, have had to undergo many months of extra training and are required to undertake between 40 & 60 newborn examinations before being deemed competent. These conditions became onerous for midwives as it became difficult for them to find mentors and assessors to support them in practice. Many requested extensions and in some cases took almost two years to complete. This model of learning was not sustainable in the long run for both the clinical workplace and for university processes. Therefore an opportunity arose to change how BU provided examination of the newborn (EXON) when the post registration framework was re-validated in 2012, with the main difference being in relation to the examinations.

Midwifery is a self-regulating profession; therefore it is up to individual practitioners to judge whether they are component when providing midwifery care. The philosophy of self-regulation underpinning competency guided the provision of the new EXON course in relation to the number of examinations required. Midwives have to carry out a minimum of 10 mentored newborn checks, with five examinations being directly supervised. Once 10 examinations have been carried out midwives can undertake as many self-assessed newborn checks until they feel competent. Once they have reached this point they put themselves forward for one summative assessment which is a newborn examination evaluated in practice. Midwives have nine months to complete the module. In addition, to further support midwives in training for this role, experienced midwives around the BU patch and as far as West Wiltshire have been provided with a half day update focusing on mentoring/assessing and understanding the EXON paperwork. These midwives have now taken on the role of mentoring and assessing midwives through EXON.

Now having delivered the six day programme the midwives in Eastbourne have successfully completed the academic requirement,s with all passing their ‘enquiry-based learning’ presentations which focused on an aspect of newborn physiology/pathology. The presentations were of an extremely high standard and feedback from the unit leader recommended writing up their work for publication in the British Journal of Midwifery. Their unit evaluations were 100% positive. One of the main benefits centered on the midwives forming a cohesive group and getting to know each other better. These midwives are leading the way at East Sussex Healthcare. Once they qualify, they in turn, can become mentors and assessors for the next cohort. Perhaps even more importantly, evidence demonstrates that when midwives undertake this expanded role, women’s satisfaction and midwifery autonomy is increased and crucially, there is continuity of care for the woman and her baby and for the midwife herself.

Five pre-registration midwifery students were successful in their application to take part in a pilot project which will equip them with the knowledge, skills and competency to undertake examination of the newborn prior to qualification as a midwife. Midwives have always undertaken an initial examination of a baby soon after birth and the 24 hour ‘medical’ examination was traditionally undertaken by junior doctors or GP trainees. Following a change in doctor’s hours and a call for more holistic midwifery care, midwives began to take on the role of examining newborns following a period of rigorous training and education delivered through universities throughout the UK. Bournemouth University, for many years now, has been actively involved in educating midwives into this role, both locally and as far a field as Brighton and Gloucester. Currently the under-graduate midwifery curriculum does not offer this learning to its midwifery students although there is a strong push nationally for students to qualify with the skills. Two universities have already embedded the skills into their three year curriculum and BU will begin to educate and train students with the necessary skills/competencies in 2014 with a brand new midwifery curriculum. In the meanwhile we are fast tracking five motivated students. The students (Bex, Jenna, Katie, Luzie and Jeanette (not in photograph) have to access all the post grad teaching and learning days (x5) which started last week. As well as undertaking an assessed presentation (6th day) with their qualified colleagues, they will have to undertake 30 newborn examinations under the watchful eye of their midwifery mentor who already has the qualification. The unit leader (myself) will undertake their final assessment in practice in conjunction with their mentor. If successful the students will be awarded with 20 CPD credits for use after qualification.

Undertaking the pilot will be demanding for the students as they will still have to obtain their EU midwifery numbers, but it will not be at the expense of the pilot. Their under-grad training takes precedence.Furthermore a number of conditions were attached to the offers of a place: the pilot cannot be used as mitigation for any referred unit in their 3rd year and the credits cannot be used to top up their degree should they not achieve the requisite 120 credits for completion. All the students expressed strong commitment to obtaining the necessary skills and they have until September 2014 to complete. The pilot will pave the way for the new curriculum and will help with exposing any shortfalls in practice. I am immensely proud of the students for taking on this extra work. They have so many competing demands on their time and this will be just another. However it will provide the students with the skills to examine newborn babies when they are newly qualified midwives, which in turn will benefit women and their babies. If anybody is interested in knowing more about the pilot please contact me on: lcbutler@bournemouth.ac.uk

Fresher’s week for midwifery students started with a hard copy photograph. The image had to depict themselves and what midwifery meant to them. This was used as an ice-breaker for the very first session and students had five minutes to share their photo with the person next to them, before that person fed back to the group the student’s name, and how the photo depicted their commitment to midwifery.The students were wonderfully creative and inventive. Many had accessed the 6 C’s and based their image around the values of care, compassion,commitment and communication, all important attributes that midwives bring to the profession. Some photographs depicted the students with midwifery related objects such as stethoscopes, pinards, and fob watches, whilst others were shown working with children/adults and one even washing an elephant on an international placement! All shared a common theme, enabling and facilitating others.

As an ice-breaker it worked particularly well as the room hummed with animated conversation, but there was a secondary purpose to the activity. It was also a ‘dummy’ run to see if it would work as an interview activity for the forthcoming 2013-2014 selection days for under-graduate pre-registration midwifery students. The interview process to select new students consists of a number of activities, one of which was a team activity. In previous years students were asked to participate in fictionalized scenarios, which consisted of survival on a lifeboat with limited provisions, being stranded in a forest in the snow after a plane crash and latterly a ‘real life dilemma’ based around prioritizing staff requests for holidays in August or having Xmas and New Year off. Students had to work as a team and after a twenty minute discussion agree on priorities relating to the particular scenario. These activities enabled the interviewers to see which prospective students were team players, which students actively contributed and whether anybody in particular dominated proceedings. During the 1:1 interview which followed, students were asked about how they felt they had contributed. It was interesting to compare interviewer gradings with the student’s own insight into their participation.

This year the current admissions tutors were keen to try something new – hence the photograph activity. Prospective candidates will be asked to bring along a photograph to their interview and will have been directed to draw links to one of the identified 6 C’s and to articulate it during their presentation. Each candidate will be partnered with one other during the activity and then asked to feedback each others’ thoughts to the whole group. Interviewers will score the candidates on the following: Communication (verbal & non verbal), how the particular ‘C ‘ was verbalized, creativity of the photograph, listening skills and how the role of the midwife is identified. Ultimately as the activity will be time restricted it is hoped that the candidates will be able, through their photographs to summarize, with reference to the 6 C’s, the values and attributes of a midwife.

If anybody is interested to know more about the process, please contact Midwifery Admission tutors on the West campus: Susan Mant on smant@bournemouth.ac.uk, and Sarah Emberley on semberley@bournemouth.ac.uk and on the East Campus: Jan Stosiek on jstosiek@bournemouth.ac.uk and Jane Fry on jfry@bournemouth.ac.uk.

Every three months hospital and community midwives at Salisbury NHS Trust Hospital attend a forum dedicated to matters relating to Examination of the Newborn (EXON). The aims of the forum are to support healthcare professional undertaking newborn examinations, sharing of experiences/case studies, interprofessional working, maintenance of competence, formulate and review internalprocesses and peer support for professionals in training. Members consist of midwives, nurses, a consultant Paediatrician and Children’s physiotherapists. BU student midwives are welcome to attend when working with their community midwives and on this occasion two students were present. As unit leader for EXON at BU and one of the link lecturers at the hospital, I chair, coordinate and facilitate the forums, with venues alternating between hospital and community. This month we met for breakfast at a colleague’s home, where midwives were greeted with the smells of freshly brewed coffee and a newly prepared home cooked frittata. Further offerings included fresh strawberries, raspberries, warm croissants, cocktail sausages and quails eggs.

Minutes and agendas are sent out in advance. A standing item is a report from senior children’s physiotherapist Karen Robinson, whose department leads the service for Developmental Dysplasia of the Hips (DDH) in newborns.A recent case was brought to our attention, where a baby had been examined by midwives and doctors and found to have an unstable right hip. The baby was appropriately referred for an ultrasound scan which subsequently found the right hip normal, but considered the left hip abnormal.The Barlow’s and Ortolani manoeuvres used by both professions at the time of the examination had not detected any left hip abnormality. A robust discussion ensured as to the complexities of examining babies for DDH and the difficulties in detecting unstable hips when the manoeuvres used by all professionals were themselves unreliable. However Karen was able to reassure us by indicating that in the seven years of the Children’s Physiotherapy Department leading the DDH service, very few babies had been ‘missed’. Karen also emphasized the significance of caring for babies’ hips in general and the importance of educating parents around their baby’s ‘hip health’. The 3rd year midwifery students are currently taught theory around DDH with opportunities to practice manoeuvres on ‘Baby Hippy’. As facilitator for these sessions I realized that our midwifery curriculum had to include general baby hip health in the first year of the student’s programme. Rachael, a 3rd year student midwife, was in agreement: “the discussion around hip care for newborns was great to listen to. I agree that it would be really beneficial to have a lecture on hip care for students”.

On other matters Karen highlighted a number of babies diagnosed with Erb’s Palsy following birth had recently been treated by the department. Various options were offered as to why these babies had sustained these birth injuries, resulting in the forum unanimously agreeing that education around Erb’s Palsy and Brachial Plexus Injuries would benefit all professionals involved with childbirth. Terri Coates, an expert on Brachial Plexus Injuries and a midwife at Salisbury, agreed to arrange a study day with the national Erb’s Palsy Support Group, to be held at either Salisbury Hospital or BU for midwives and students.

There are many advantages in having a regular forum to discuss issues relating to newborn examination.Case studies are presented and debated and education around various topics are provided at regular intervals. The forum also supports midwives from other trusts who are having difficulties with undertaking the examination in their areas. Beccy, the 1st year student midwife had the following to say: “It was very informative. It was good to see community and hospital midwives coming together as a team. I am also interested in learning more about Erb’s Palsy and attending a study day. Learning about general hip care would also be beneficial. The breakfast was lovely too”.

Dizzy

The last bark, I mean word, goes to Dizzy. He gets terribly excited when breakfast is served and runs from one midwife to another hoping for a dropped sausage or at least a titbit from a kind soul. After not having much luck, he eventually settles down and gently snores in the corner of the room.

Undergraduate pre-registration first year midwifery students were enthralled at a recent theme day which formed part of their Intrapartum unit. The day is designed to celebrate diversity of women’s experiences during labour where students get to listen to stories of women and midwives. This year’s gathering was no exception. First up was Rachel Arnold, a PhD student from BU. Her rich story, supported by beautiful photographs of Afghanistan, highlighted the plight of women in that country, where maternal mortality is amongst the highest in the world. Rachel in her role as a midwife has worked with Afghan people for many years and as she shared her experiences we began to see that Afghanistan is more than ‘suicide bombers and conflict’, it is about ordinary people who struggle to survive each and every day. Rachel’s talk inspired the whole audience and many students were interested to find out if they could go to Afghanistan for their elective which occurs in the 3rdyear of their training.

“It was wonderful to have a midwifery perspective from this country and the lecture was inspiring and passionate”

“Very interesting and thought provoking talk which has made me think about my own attitudes on diversity”

Jane Evans, an independent midwife, spoke about breech birth as a normal event during pregnancy. She shared a number of photographs showing how a breech birth should be facilitated with the mantra “hands off”, and students were able to see how the baby rotated , flexed and birthed itself with the help of his/her mother adopting a variety of positions. The mechanisms were reinforced through Jane using a doll and pelvis to further enhance student understanding. Many midwives are losing their skills within breech birth as women are often opting for caesarean section, but Jane was fortunate in that she was taught the craft of breech (bottom down) birth by Mary Cronk, who specialised in independent midwifery practice with a keen interest in breech presentation. Mary is now retired but thankfully her many years of experience were passed onto Jane who shares her knowledge widely through study days and of course with the midwifery students at BU. Many of the students’ views were changed following Jane’s presentation, as the following quotation demonstrates: “It was a privilege to hear this lecture. It offered a contrast to other breech perspectives and gave me more confidence as a student midwife to educate women that breech is merely another type of normal”

Sheetal Sharma, another BU PhD student provided the students with her insight into midwifery care in Nepal. She warned us that she was not a midwife, and was observing and recording midwifery practice as part of her doctoral studies. She provided a fascinating insight into how pregnancy and childbirth are perceived in Nepal where women have no rights within their own homes and are subject to the control, whims and superstitions of their ‘mother-in-laws’. There were also parallels with Afghanistan in relation to maternal mortality, as around 4,500 Nepalese women die in childbirth due to a paucity of adequate healthcare or even skilled birth attendants. Sheetal’s presentation included fabulous photographs of idyllic scenes in Nepal, but also of women and children where smiles were abundant and hope was evident. Nepal has made significant strides to reduce maternal mortality and is now on track to meet Millennium Development Goal (MDG)4.

Sheetal explaining her photograph where a woman is shown holding a scythe. Not only is this a tool used in the field to cut vegetation but also as an implement to cut the baby’s cord at birth.

The last presentation by Vanora Hundley, BU’s Professor of Midwifery, focused on the global picture of maternal and child health, where some of the key interventions that save mothers and babies lives were highlighted. Vanora reminded the audience that, for example, having a skilled attendant at birth may not always be thought of as ‘intervention’, but evidence shows that countries where women have access to midwives or an attendant with midwifery skills have significant lower maternal mortality rates. Finally, a note of caution was provided by Vanora around the challenges faced in high income countries, as the over-use of interventions by health professionals are having a damaging impact on mothers and babies.

The students really enjoyed the day as the following quotes illustrate:

“I have thoroughly enjoyed the theme day, it has been very informative and insightful – more so than I had anticipated”.

“Fantastic to have a (nearly!) whole day of the wider context of midwifery. Inspirational – thanks”.

“Absolutely superb day. Reignites the fire in your belly!”

“Really insightful day. Demonstrated the importance of the midwife and our roles, not just at home but around the world. It’s nice to see the bigger picture”.

In August 2012 a call was put out through the midwifery networks by the Preterm Birth Clinical Study Group (CSG) who were seeking to recruit new members. The Preterm Birth CSG aims to identify important research questions around preterm birth and to work with the originators of supported studies around preterm birth, and to improve clinical outcomes following preterm birth by prevention or intervention.

This group, one of 11 CSGs, is a Royal College of Obstetrics and Gynaecology (RCOG) specialist group supported by British Maternal and Fetal Medicine Society (BMFMS), British Association of Perinatal Medicine (BAPM) and by Action Medical Research. Applications were welcomed from obstetricians, neonatologists and midwives who were interested in preventing preterm birth or in improving outcomes. I (Luisa Cescutti-Butler) was successful in my application and attended my first meeting on the 23rd April 2013 in Dublin.

Most of us were new to the group and following introductions we set to business. An urgent consideration was the representation of lay members. There were a number of suggestions put forward as to how lay members could be approached and groups such as MumsNet, Bliss and Bounty were to be approached for their views on research priorities within preterm birth. The group also felt that establishing a focus group of women who had experienced a preterm birth would be valuable and I offered to facilitate this.

A number of research projects were discussed and whilst many of these studies were focused on RCT’s and not within my comfort zone, I was able to provide input into some where a qualitative approach would work. Many of the professors around the table were comfortable with scientific methodologies, but were open to the possibilities of where proposed projects might benefit from a qualitative perspective, i.e. inviting women to speak about their experiences of possible interventions to prevent preterm birth.

Following the Preterm Birth Clinical Study Group meeting on the 23rd April 2013, I was fortunate to attend on the following two days a conference arranged by the British Maternal and Fetal Medicine Society (BMFMS) of which I am a member. The programme, which consisted of high quality clinical and basic science key lectures and presentations were fascinating for me as a midwife, although I did feel at various points throughout the two days that if it were left to ‘science’, women would never have an opportunity to have a normal pregnancy and birth. It appeared that every step of the childbirth continuum could be researched, with outcomes managed in some way because of ‘evidence,’ which for some women who experience life threatening conditions such as pre-eclampsia is of vital importance. In the event, I was able to gain information that would benefit BU undergraduate midwifery students. At the end of the conference I was in awe of all the high quality research being undertaken in the UK to prevent preterm birth and obstetric conditions such as pre-eclampsia, but also a little sad. Sad at the prospect that if midwives don’t continue to protect normality for women, it might fall forever within the realms of ‘medicine’ and who knows where pregnant women will end up? And finally in conclusion, I never did get to taste a Guinness in one of the many traditional Irish Pubs scattered around the city, so couldn’t say whether it tasted better in Dublin or not!

Slovenia, once part of communist Yugoslavia, is now an independent country which borders Italy, Croatia, Austria and Hungary. It is a modern and young economy with a strong infrastructure. Midwifery has been practised in the region for hundreds of years; however a decision to suspend midwifery training in the 1980s resulted in a severe shortage of midwives. In 1996 midwifery education was reinstated, but this time within higher education. In 2002 the first midwives were able to qualify with a degree from the University of Ljubljana, which offers the only undergraduate midwifery programme in Slovenia.

The role of the midwife in Slovenia is mainly concentrated within the area of intrapartum care; a consequence of the midwifery shortage that saw midwives drawn from other areas to cover labour and birth. Very little antenatal and postnatal care is offered by midwives. These aspects of care are typically provided by gynaecologists, obstetricians, paediatricians and community nurses. Thus there have been calls for midwives to increase their role within public health and to develop primary care services. One aspect of care that could develop midwifery practice is examination of the newborn.

A scoping visit funded by ERASMUS (British Council) and EUNF (Bournemouth University) was undertaken by Luisa Cescutti-Butler (Senior Lecturer) and Professor Vanora Hundley at the behest of the Head of Midwifery Dr. Ana Polona Misvek at the University of Ljubljana. The visit explored whether midwives, paediatricians, neonatologists and midwifery lecturers would be receptive to a course that would teach Slovenian midwives to examine normal healthy term babies. This examination is currently only undertaken by paediatricians.

A round table discussion was arranged with key professionals from the medical and midwifery community. The discussion was at times fairly animated; for example there was strong opposition from the neonatologist who believed that midwives were not ready to take on this role. In contrast, there was encouraging agreement from Professor Dr. Ciril Kržišnik (Senior Paediatrician and Head of the Paediatric Association) who was present, and Anita Prelec (Head of the Slovenian Nursing/Midwifery Association).

A positive outcome was the desire from all professionals to strengthen the midwife’s role within the initial examination of the newborn and it is this aspect of care and knowledge that offers further opportunities for future collaboration and training.